Barriers and facilitators for recognising and discussing palliative care needs of homecare clients: an interviews study among household assistants, welfare workers, nurses and nurse assistants

Background People with an incurable illness may develop palliative care needs during the course of their disease. In homecare, nurses, nurse assistants, welfare workers, and household assistants can be the first to notice deterioration, as they spend much time with clients. However, it remains unclear which factors facilitate or hinder them in this role. We therefore conducted an interview study on barriers and facilitators for recognising and discussing palliative care needs of homecare clients. Methods We conducted a qualitative interview study using semi-structured interviews, including eight group interviews and 11 individual interviews with 10 household assistants, 9 welfare workers, and 25 care workers from four organisations. Interviews were conducted face-to-face and online, and transcripts were analysed thematically. Results Four themes were identified. First, knowledge: nurses and nurse assistants have medical knowledge to recognise deterioration, while most welfare workers and household assistants lack this training. All disciplines specifically reported a gap in palliative care knowledge. Second, time: nurses often lack time to recognise and discuss deterioration, while welfare workers and household assistants spend more time with clients, which facilitates recognising changes despite their knowledge gap. Third, collaboration and communication: nurses, nurse assistants, and welfare workers can report observations, but household assistants have limited opportunities to share their potentially valuable information. Finally, all disciplines indicated that good relationships with clients and relatives are essential for recognising and discussing deterioration, as this helps clients and relatives feel comfortable expressing their wishes and needs. Conclusions What is perceived as a barrier for one discipline can be a facilitator for another, and vice versa. Palliative care education and stronger collaboration and communication between disciplines are essential to support homecare staff in recognising and discussing palliative care needs. Finally, good relationships with clients and relatives help create a safe environment that brings together different perspectives, supporting the care the client wishes to receive.